Publisher: Elsevier   (Total: 3206 journals)

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Showing 1 - 200 of 3206 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 8)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 449, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 340, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 3, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 14, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 198, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 1)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 14)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 69, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 10, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 435, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 36, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 400, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 483, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 56, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 17, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 35, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 51)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 1)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 277, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 26, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 224, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Ophthalmology
Journal Prestige (SJR): 3.184
Citation Impact (citeScore): 4
Number of Followers: 67  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9394 - ISSN (Online) 1879-1891
Published by Elsevier Homepage  [3206 journals]
  • Postoperative Blepharoptosis After Modern Phacoemulsification Procedure
    • Abstract: Publication date: May 2020Source: American Journal of Ophthalmology, Volume 213Author(s): Mohsen Bahmani Kashkouli, Parya Abdolalizadeh, Acieh Es'haghi, Naveed Nilforushan, Hossein Aghaei, Nasser Karimi
       
  • Presentation and Progression of Papilledema in Cerebral Venous Sinus
           Thrombosis
    • Abstract: Publication date: May 2020Source: American Journal of Ophthalmology, Volume 213Author(s): Katy C. Liu, M. Tariq Bhatti, John J. Chen, Aaron M. Fairbanks, Rod Foroozan, Collin M. McClelland, Michael S. Lee, Celine E. Satija, Courtney E. Francis, Michael T. Wildes, Prem S. Subramanian, Zoë R. Williams, Mays A. El-Dairi
       
  • “There Are Hills and Valleys”: Experiences of Parenting a Son With
           X-Linked Retinoschisis
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Amy Turriff, Rosalie Nolen, Celeste D'Amanda, Barbara Biesecker, Catherine Cukras, Paul A. Sieving
       
  • Specific PCR and Quantitative Real-Time PCR in Ocular Samples from Acute
           and Delayed-Onset Postoperative Endophthalmitis
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Julie Kosacki, Sandrine Boisset, Max Maurin, Pierre-Loic Cornut, Gilles Thuret, Ralitsa Hubanova, Francois Vandenesch, Anne Carricajo, Florent Aptel, Christophe Chiquet, Friends Group
       
  • Accuracy of Intraocular Lens Formulas in Eyes With Keratoconus
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Kendrick M. Wang, Albert S. Jun, John G. Ladas, Aazim A. Siddiqui, Fasika Woreta, Divya Srikumaran
       
  • Increased expression of growth hormone-releasing hormone in fibrinous
           inflammation of proliferative diabetic retinopathy
    • Abstract: Publication date: Available online 14 February 2020Source: American Journal of OphthalmologyAuthor(s): Yong Jie Qin, Sun On Chan, Hong Liang Lin, Yu Qiao Zhang, Bei Ting He, Liang Zhang, Hong Hua Yu, Wai Kit Chu, Chi Pui Pang, Hong Yang Zhang
       
  • Anti-inflammatory medication after cataract surgery and posterior capsular
           opacification
    • Abstract: Publication date: Available online 14 February 2020Source: American Journal of OphthalmologyAuthor(s): Idan Hecht, Petteri Karesvuo, Asaf Achiron, Uri Elbaz, Ilkka Laine, Raimo Tuuminen
       
  • Morphologic Features of Buried Optic Disc Drusen on En Face Optical
           Coherence Tomography and Optical Coherence Tomography Angiography
    • Abstract: Publication date: Available online 24 January 2020Source: American Journal of OphthalmologyAuthor(s): Min Seok Kim, Kyoung Min Lee, Jeong Min Hwang, Hee Kyung Yang, Se Joon Woo
       
  • Gender of Presenters at Ophthalmology Conferences between 2015-2017
    • Abstract: Publication date: Available online 23 January 2020Source: American Journal of OphthalmologyAuthor(s): Sejal H. Patel, Timothy Truong, Irena Tsui, Jee-Young Moon, Jamie B. Rosenberg
       
  • Simultaneous bilateral pediatric and juvenile cataract surgery under
           general anesthesia: outcomes and safety
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Katharina Eibenberger, Eva Stifter, Franz Pusch, Ursula Schmidt-Erfurth
       
  • Changes in Choroidal Thickness Varied by Age and Refraction in Children
           and Adolescents: A 1-Year Longitudinal Study
    • Abstract: Publication date: May 2020Source: American Journal of Ophthalmology, Volume 213Author(s): Shuyu Xiong, Xiangui He, Bo Zhang, Junjie Deng, Jingjing Wang, Minzhi Lv, Jianfeng Zhu, Haidong Zou, Xun XuPurposeTo clarify the changing characteristics of choroidal thickness over time within different age ranges and among different refractive statuses of children aged 6 to 18 years.DesignProspective cohort study.MethodsData of axial length, cycloplegic refraction, and choroidal thickness (using swept-source optical coherence tomography) were collected at baseline and at a 1-year follow-up for 756 participants. One-year change in choroidal thickness and its association with age and refraction were analyzed.ResultsSignificantly greater attenuation of choroidal thickness was observed in younger children aged 6-9 years for all participants (−9 ± 25 μm) and for those with a myopic shift (−12 ± 25 μm), whereas there was a larger increase in adolescents aged 10-13 years for those without a myopic shift (9 ± 23 μm). There was a marked decrease in the choroidal thickness for newly developed myopic patients compared with persistent-nonmyopic patients and persistent-myopic patients (P < .01). The association between changes in axial length and choroidal thickness was less strong in persistent-myopic patients (β = −15.4, P = .022) than that in persistent-nonmyopic patients (β = −30.4, P < .001) and newly developed myopic patients (β = −33.7, P = .001), whereas among the persistent-myopic patients, the association was less strong in the baseline mild-myopic patients (β = −10.4, P = .193) than that in the baseline moderate-to high-myopic patients (β = −31.4, P = .026).ConclusionsChanges in choroidal thickness varied by age. There was an increased rapid thinning of the choroid among newly developed myopic patients, and a nonsignificant association between changes in choroidal thickness and axial length in the early stages of myopia.
       
  • Visual Function and Disability Are Associated with Increased Retinal
           Volumetric Vessel Density in Patients with Multiple Sclerosis
    • Abstract: Publication date: May 2020Source: American Journal of Ophthalmology, Volume 213Author(s): Hong Jiang, Giovana Rosa Gameiro, Yi Liu, Ying Lin, Jeffrey Hernandez, Yuqing Deng, Giovanni Gregori, Silvia Delgado, Jianhua WangPurposeThe goal of this study was to determine the volumetric vessel density (VVD) in the intraretinal layers and its relationship with visual function and disability in patients with multiple sclerosis (MS).DesignCross-sectional study.MethodsA total of 80 patients with relapsing-remitting MS and 99 age- and sex-matched healthy controls (HC) were recruited. The retinal microvascular network in the macular area was imaged using optical coherence tomography angiography in 123 eyes without a history of optic neuritis (ON) (MSNON) and 36 eyes with a history of ON (MSON). The VVD was calculated as the vessel densities in the retinal vascular network (RVN), superficial vascular plexus (SVP), or deep vascular plexus (DVP) of an annulus (0.6-2.5 mm in diameter), divided by the corresponding tissue volume of the intraretinal layers respectively.ResultsThe VVD of RVN and DVP in MSNON were significantly higher than in HC (P < .05). The VVD of RVN, SVP, and DVP in MSON were significantly higher than in MSNON and HC (P < .05). The VVD in both RVN and SVP were positively related to EDSS and disease duration, but negatively related to low-contrast letter acuity (P < .05). The VVD measurements were also negatively and strongly related to the corresponding tissue volumes (P < .05).ConclusionsThis is the first study to reveal increased retinal VVD in patients with relapsing-remitting MS. The measurements of VVD in the RVN and SVP were related to disability and visual function, which may be developed as image markers for tracking disease progression.
       
  • Visual Impairment and Major Eye Diseases in Chronic Kidney Disease: The
           National Health and Nutrition Examination Survey, 2005-2008
    • Abstract: Publication date: May 2020Source: American Journal of Ophthalmology, Volume 213Author(s): Zhuoting Zhu, Huan Liao, Wei Wang, Jane Scheetz, Jian Zhang, Mingguang HePurposeTo investigate the prevalence and associations of visual impairment (VI) and major eye diseases with chronic kidney disease (CKD) in the United States.DesignCross-sectional study.MethodsWe investigated the prevalence and associations of VI and major eye diseases with CKD among 5,518 participants aged 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey. An estimated glomerular filtration rate of lower than 60 mL/min/1.73 m2 was defined as CKD. Corrected visual acuity of worse than 20/40 in the better-seeing eye was defined as VI. Major eye diseases, including any ocular disease, any objectively determined ocular disease, cataract surgery, any retinopathy, diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma were evaluated from questionnaire or retinal photographs using standardized grading protocols.ResultsThe prevalence of VI and major eye diseases were approximately 2- to 7-fold higher in participants with CKD than in those without (all P < .05). After controlling for multiple confounders, the presence of CKD was associated with VI (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.14-3.54), any ocular disease (OR: 1.65, 95% CI: 1.22-2.22), any objectively determined ocular disease (OR: 1.52, 95% CI: 1.06-2.19), any retinopathy (OR: 1.70, 95% CI: 1.18-2.45), and DR (OR: 2.34, 95% CI: 1.23-4.42). There was no association of CKD with cataract surgery, AMD, or glaucoma. A significant association between CKD and any ocular disease was observed among nondiabetic participants. The presence of CKD was closely related to VI and any retinopathy among diabetic participants.ConclusionsThis nationally representative sample of the US population demonstrated high prevalence and strong associations of VI and major eye diseases with CKD, highlighting the importance of ocular screening among CKD patients and potential common pathogenesis underlying these conditions.
       
  • Near-Infrared Reflectance Imaging for Quantification of Atrophy Associated
           with Age-Related Macular Degeneration
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Nizar Saleh Abdelfattah, Jaya Sadda, Ziyuan Wang, Zhihong Hu, Srinivas SaddaPurposeTo compare measurements of area of geographic atrophy (GA) in dry age-related macular degeneration (AMD) obtained by fundus autofluorescence (FAF) to those obtained by near-infrared reflectance (NIR).DesignInterrater reliability analysis.MethodsNinety-seven confocal NIR images (Heidelberg HRA + Spectralis) and FAF images from 97 patients/eyes with GA with dry AMD were collected retrospectively from existing anonymized Doheny Image Reading Center datasets. Two masked reading center graders (N.S., J.S.) independently and blindly performed manual segmentation of the GA lesions on each NIR and FAF image using GNU Image Manipulation Program software (version 2.8.22). GA on NIR/FAF images was defined in accordance to recently published Classification of Atrophy Meeting criteria as sharply demarcated hyperreflective regions ≥250 μm in diameter. The difference and point-to-point correspondence between gradings in GA area measurements between NIR and FAF were assessed by mean difference, overlap ratio, and Dice similarity coefficient.ResultsAmong the 97 eyes with dry AMD, the mean GA area was 7.62 ± 7.77 mm2 from FAF images and 7.65 ± 7.83 mm2 from NIR, with a mean nonsignificant difference of 0.31 ± 0.55 mm2 (2-tailed t test, P = .65). The overlap ratio in the segmented GA lesion between modalities was 0.84 ± 0.28 with a Dice similarity coefficient of 0.87 ± 0.27. Intermodal reliability was high (intraclass correlation coefficient = 0.998, P < .01). Of note, in 5 cases (5.2%), the GA lesion could be identified on the FAF image but not on the NIR image, translating into a sensitivity of 94.8%.ConclusionsGA lesions in dry AMD can be identified and quantified reliably using NIR images in many cases, though eyes with a thin choroid resulting in isoreflective GA lesions may be challenging. NIR imaging is comfortable for patients and is commonly obtained along with OCT, and therefore NIR-based GA assessment may be a useful surrogate in clinical settings.
       
  • Anterior Chamber Angles in Different Types of Mucopolysaccharidoses
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Jia-Rong Zhang, Jen-Hung Wang, Hong-Zin Lin, Yuan-Chieh LeePurposeTo evaluate the anterior chamber angle status and estimate the intraocular pressure (IOP) in patients with mucopolysaccharidoses (MPSs) type I, II, IV, and VI.DesignProspective cross-sectional study.MethodsThis study enrolled 27 consecutive MPS patients (8 patients with MPS I, 4 patients with MPS II, 9 patients with MPS IV, and 6 patients with MPS VI) and 20 normal control subjects. Anterior chamber angle status was evaluated by swept-source optical coherence tomography and IOP was estimated by the new-generation tonometer Corvis ST.ResultsTwelve eyes (6 patients) of 15 eyes (8 patients) with MPS I had narrow angles or peripheral iridocorneal touches together with elevated IOP (80%). Six eyes (3 patients) of 8 eyes (4 patients) with MPS II had plateau iris configuration, but all 8 eyes had normal IOP. All 18 eyes (9 patients) with MPS IV had normal angle structures, but 8 eyes (4 patients) had elevated IOP (44.4%). Nine eyes (5 patients) of 11 eyes (6 patients) with MPS VI had shallow but not closed angles (81.8%). Among these 9 eyes, 5 eyes had elevated IOP, and 4 of these 5 eyes had IOP>30 mm Hg. The trabecular iris angles of MPS types I, II, and VI were smaller than those of MPS type IV and of the control subjects. The angle recess areas of MPS types I and VI were smaller than those of MPS type IV and of the control subjects.ConclusionsMPS type I patients are prone to have glaucoma with narrow or closed angles; MPS type II patients tend to have plateau iris; MPS type IV patients are vulnerable to open-angle glaucoma; MPS type VI patients have narrow angles not as close as those of MPS type I. MPS types I, IV, and VI had higher IOP estimates than the control subjects, but only MPS I and IV had higher corrected IOP estimates than the control subjects. The ordinary IOP estimates in MPS VI patients may be falsely high because of clouded corneas and increased corneal rigidity. Swept-source optical coherence tomography helps ophthalmologist investigate the angle structure and the pathophysiology of glaucoma caused by MPS.
       
  • Accelerated corneal cross-linking: Efficacy, risk of progression, and
           characteristics affecting outcomes. A large single-centre prospective
           study
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Wendy Hatch, Sherif El-Defrawy, Stephan Ong Tone, Raymond Stein, Allan R. Slomovic, David S. Rootman, Theodore Rabinovitch, Christoph Kranemann, Hall F. Chew, Clara C. Chan, Matthew C. Bujak, Ashley Cohen, Gerald Lebovic, Yaping Jin, Neera SingalAbstractPurposeWe examined the efficacy and preoperative characteristics that affect outcomes of accelerated (9 mW/cm2 for 10 minutes) corneal cross-linking (CXL).DesignProspective single-centre observational cohort studyMethodsWe enrolled 612 eyes of 391 subjects with progressive keratoconus (n=589), pellucid marginal degeneration (PMD) (n=11) and laser in situ keratomileusis (LASIK)-induced ectasia (n=12). We evaluated best spectacle corrected visual acuity (BSCVA), topography, refraction, endothelial cell density, corneal thickness, haze, intraocular pressure and visual function before and 12 months after the CXL procedure. We tabulated the proportion of those with progression of maximum keratometry (Kmax). We included race, age, gender and the presence of preoperative apical scarring and environmental allergies in a multivariable linear regression model to determine the effect of these characteristics on outcomes.ResultsAt one year there was no significant change in mean Kmax (n=569). Progression of KMax was higher in subgroups with baseline Kmax>58D (n=191) and 14-18 years of age (n=53). Preoperative BSCVA, Kmax, refraction, corneal cylinder, coma, central corneal thickness (CCT) and vision function were statistically and clinically significant predictors of outcomes. (p
       
  • Medication Adherence in Patients with Glaucoma After Cancer Diagnosis
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Chiun-Ho Hou, Ken-Kuo Lin, Jiahn-Shing Lee, Christy PuAbstractPurposeTo determine the association between cancer diagnosis on medication adherence in patients with glaucoma.DesignCohort studyMethodsSetting: Population-based.Study Population: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within one year of a confirmed glaucoma diagnosis or who were dead within one year after a confirmed cancer diagnosis were excluded. Intervention or Observation Procedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period.Main Outcome Measure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals.ResultsFor both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370–0.388) for the cancer group and 0.313 (95% CI: 0.308–0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% (p < 0.001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (p < 0.001) and 9.21% (p < 0.001), respectively.ConclusionsCancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer.
       
  • Ophthalmological findings in fetal alcohol spectrum disorders – a cohort
           study from childhood to adulthood
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of OphthalmologyAuthor(s): Emelie Gyllencreutz, Eva Aring, Valdemar Landgren, Leif Svensson, Magnus Landgren, Marita Andersson GrönlundAbstractPurposeTo investigate whether ophthalmological findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood.DesignProspective cohort study.MethodsThirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13–18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media and fundus were investigated.ResultsMedian VA right/left eye (RE/LE) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction RE/LE was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1D) was the most common refractive error;13 (40%) and 14 (47%), respectively. Defective stereoacuity (>60”) was noted in 20 (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in eight (27%) participants in childhood versus eleven (37%) in adulthood. Optic nerve hypoplasia was recorded in three children and in four young adults.ConclusionsOphthalmological findings such as refractive errors, strabismus and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmological examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.
       
  • Pattern electroretinograms in preperimetric and perimetric glaucoma
    • Abstract: Publication date: Available online 20 February 2020Source: American Journal of OphthalmologyAuthor(s): Kyoung In Jung, Sooji Jeon, Da Young Shin, Jiyun Lee, Chan Kee ParkAbstractPurposeTo investigate whether visual function can be graded in detail using pattern electroretinogram (PERG) in preperimetric to perimetric glaucomaDesignCross-sectional observational studyMethodsTwenty-six normal subjects, 113 preperimetric glaucoma patients (which included glaucoma suspect patients), and 52 early perimetric glaucoma patients with a mean deviation (MD)> -10dB were included. Structural and functional measurements were performed using spectral-domain optical coherence tomography and a commercial ERG stimulator, respectively.ResultsThe average retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness were thinnest in perimetric group followed by the preperimetric group and the control group (P
       
  • Reduced risk of recurrence of non-infectious posterior segment uveitis
           after 0.18 mg fluocinolone acetonide insert: Randomized Trial
    • Abstract: Publication date: Available online 20 February 2020Source: American Journal of OphthalmologyAuthor(s): David Callanan, Quan Dong Nguyen, Eric B. Suhler, Dario Paggiarino, Gerard E. Riedel, the FA Insert study groupAbstractPurposeTo evaluate the safety and efficacy of 0.18 mg fluocinolone acetonide intravitreal (FAi) insert in chronic non-infectious uveitis affecting the posterior segment of the eye.DesignProspective, multicenter, randomized, doubled-masked, sham-controlled, 3-year, phase 3 clinical trial.MethodsEligible patients were randomized in a 2:1 ratio to receive either FAi (0.18 mg) insert (N=87) or sham injection (N=42). Primary efficacy endpoint was the recurrence of uveitis within 6 months. Secondary endpoints were recurrence within 12 months, resolution of macular edema, change in best corrected visual acuity, intraocular pressure (IOP) and adverse events.ResultsUveitis recurrence rates were significantly lower in FAi group compared to sham at 6 (18.4 vs 78.6%; p
       
  • Correlation between office hour and peak nocturnal intraocular pressures
           in patients treated with prostaglandin analogs
    • Abstract: Publication date: Available online 20 February 2020Source: American Journal of OphthalmologyAuthor(s): Diya Yang, John H.K. Liu, Ningli Wang, Robert N. WeinrebAbstractPurposeTo test the hypothesis that the correlation between office-hour intraocular pressure (IOP) and peak nocturnal IOP is weakened after using a prostaglandin analog.DesignBefore-and-after study.Methods24-hour IOP data obtained in a sleep laboratory of 51 patients (22 open angle glaucoma and 29 ocular hypertension) were reviewed. Patients had no IOP-lowering medication upon study entry and then were treated with prostaglandin monotherapy for 4 weeks. Measurements of IOP were taken every 2 hours in the sitting and supine positions during the diurnal/wake period (7:30 AM to 9:30 PM) and in the supine position during the nocturnal/sleep period (11:30 PM to 5:30 AM). Individual and average IOP readings during office hours (9:30 AM to 3:30 PM) and peak IOP during the nocturnal/sleep hours were analyzed using Pearson’s correlation coefficient and linear regression.ResultsThere were statistically significant correlations for all the paired variables for the analyses. Average office-hour IOP had a higher correlation with peak nocturnal IOP than individual office-hour IOP. After the treatment with prostaglandin analog, the correlation between average office-hour IOP and nocturnal peak IOP in the sitting position (r=0.373) and the supine position (r=0.386) were reduced from the sitting baseline (r=0.517) and the supine baseline (r=0.573) in the right eyes. Similar change patterns appeared in the left eyes.ConclusionThere is a correlation between office-hour IOP reading and peak nocturnal IOP under no IOP-lowering treatment as well as under prostaglandin monotherapy. The strength of correlation was weaker under the treatment compared to the baseline.
       
  • Psychosocial Predictors of Glaucoma Medication Adherence among the
           Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Pilot Study
           Participants
    • Abstract: Publication date: Available online 19 February 2020Source: American Journal of OphthalmologyAuthor(s): Mariam Salman, Chris Andrews, Michele Heister, Deborah Darnley-Fisch, Paula Anne Newman-CaseyAbstractPurposeTo evaluate the association between baseline psychosocial milieu and subsequent glaucoma medication adherence among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study.DesignProspective cohort study.ParticipantsUniversity of Michigan glaucoma patients ≥ age 40, taking ≥ 1 glaucoma medication, who self-reported poor adherence.MethodsParticipants completed a baseline survey that assessed: 1) Demographics; 2) Social network; 3) Perceived Stress; 4) Consideration of future consequences; 5) Glaucoma-related distress and 6) Social support. Medication adherence was then monitored electronically (AdhereTech, New York, NY) for 3 months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and medication adherence was assessed using univariate and multivariate analysis.Main Outcome MeasuresMedian percent adherence over three months.ResultsOf the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over three months was 74% + 21% (+ standard deviation, SD). Higher income and more education were significantly associated with better adherence (p
       
  • Conjunctival biopsy site in mucous membrane pemphigoid
    • Abstract: Publication date: Available online 15 February 2020Source: American Journal of OphthalmologyAuthor(s): Giulia Coco, Vito Romano, Nardine Menassa, Davide Borroni, Katja Iselin, Daniel Finn, Gustavo S. Figueiredo, Filofteia Tacea, Elizabeth Anne Field, Sajjad Ahmad, Stephen B. KayeAbstractPurposeTo investigate if there is an association between the location of the conjunctival biopsy site (lesional, peri-lesional or unaffected) and the result of the direct immunofluorescence (DIF) test in patients with suspected mucous membrane pemphigoid (MMP) involving the ocular surface.DesignRetrospective case seriesMethodsRecords of patients with clinically suspected ocular MMP were reviewed to determine the location of the conjunctival biopsy. Conjunctival biopsy locations were defined as ‘lesional’, ‘peri-lesional’ and ‘non-affected’ conjunctiva. The DIF was considered positive, when there was deposition of at least one of either IgM, IgG, IgA, and C3 at the basement membrane of the specimen, non-diagnostic when only fibrinogen was found at the same location and negative, when none of these features were present.ResultsThe records of forty-one patients were analysed. Of these, thirty-two were eligible to be included in the study. Biopsies were ‘lesional’ in (7/32) 22% of cases, ‘peri-lesional’ in (7/32) 22% and from ‘non-affected’ conjunctiva in (18/32) 56%. DIF results were positive in 14% of ‘lesional’ biopsies, 86% of ‘peri-lesional’ and in 17% of those from ‘non-affected’ conjunctiva (p = 0.003). Peri-lesional biopsies gave higher positive DIF than lesional biopsies (p = 0.029).ConclusionsPeri-lesional conjunctival biopsies are associated with an increase in positive DIF results. These results support the need to sample peri-lesional conjunctival tissue in patients with suspected MMP.
       
  • Primary Pediatric Keratoplasty: Etiology, Graft Survival, and Visual
           Outcome
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Maria Emilia Xavier dos Santos Araújo, Namir Clementino Santos, Luciene Barbosa de Souza, Elcio Hideo Sato, Denise de FreitasPurposeInterventional study to evaluate the etiology, visual outcome and survival of corneal transplantation in children and to identify the risk factors associated with graft failure.DesignRetrospective, interventional consecutive case series.MethodsMedical records of every child 7 years of age or younger who underwent primary penetrating keratoplasty at Department of Ophthalmology, Federal University of São Paulo were reviewed. The parameters evaluated were indications for keratoplasty, graft survival, and postoperative visual acuity (VA) improvement. Children underwent ophthalmologic examination before and after corneal graft, including VA, assessed by the preferential looking test and visual evoked potential. The analysis of transplant survival was performed using the Kaplan-Meier method.ResultsFifty-six penetrating transplants were performed in 51 eyes of 43 children. The patients were divided into 2 groups: congenital (72.5%) and acquired (17.5%) corneal opacity. The main indication was congenital glaucoma (29.4%). The overall Kaplan-Meier graft survival rates were 64.7% in the postoperative average follow-up period of 24 months. There was no significant difference in graft survival between the congenital and acquired groups (Mantel-Cox P = .1031). There was significant improvement in VA in both groups (P = .0022 for congenital and P < .0001 for acquired). Rejection and diagnosis of congenital glaucoma were risk factors for graft failure.ConclusionsCongenital glaucoma was the main indication for corneal transplantation and despite the difficulties, prolonged survival and improved VA can be achieved in pediatric transplant. Complications such as rejection and early glaucoma were significantly associated with graft failure.
       
  • Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa
           Displacement in Glaucoma
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Brandon J. Wong, Sasan Moghimi, Linda M. Zangwill, Mark Christopher, Akram Belghith, Eren Ekici, Christopher Bowd, Massimo A. Fazio, Christopher A. Girkin, Robert N. WeinrebPurposeTo investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma.DesignProspective observational case series.MethodsIn this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness.ResultsThe mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI −1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of −1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS.ConclusionsLower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.
       
  • Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection
           During Deep Anterior Lamellar Keratoplasty in Keratoconus
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Vincenzo Scorcia, Giuseppe Giannaccare, Andrea Lucisano, Mauro Soda, Giovanna Carnovale Scalzo, James Myerscough, Marco Pellegrini, Francesco Verdoliva, Gabriele Piccoli, Cristina Bovone, Massimo BusinPurposeTo identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity.DesignRetrospective Cohort Study.MethodsSetting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019. Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment optical coherence tomography (AS-OCT)–based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro-/macroperforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.ResultsPneumatic dissection succeeded in 113 of 155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%), and 2 mixed-type (1.8%). Microperforations were managed conservatively in type 1 bubbles; macroperforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P = .006 and P < .013). Type 1 bubbles formed in eyes with significantly lower age, K-mean, and AS-OCT stages and higher pachymetric values (always P < .029). Age had the highest diagnostic power for discrimination between bubble types, followed by AS-OCT stage, pachymetry, K-mean, and astigmatism (respectively, AUC = 0.861, 0.779, 0.748, 0.700, 0.670).ConclusionsOlder age and advanced stages of keratoconus were predictors of type 2 bubble formation during BB-DALK that was associated with an increased risk of complications.
       
  • Twelve-Month Results of Cyclosporine A Cationic Emulsion in a Randomized
           Study in Patients With Pediatric Vernal Keratoconjunctivitis
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Dominique Bremond-Gignac, Serge Doan, Mourad Amrane, Dahlia Ismail, Jesús Montero, János Németh, Pasquale Aragona, Andrea Leonardi, VEKTIS Study GroupPurposeTo assess the safety and efficacy of cyclosporine A cationic emulsion (CsA CE) 0.1% eye drops in pediatric patients with severe active vernal keratoconjunctivitis (VKC).DesignMulticenter, double-masked, randomized controlled trial 8-month safety analysis.MethodsOf 169 patients (age range, 4-17 years) initially randomized in the 4-month VErnal KeratoconjunctiviTIs Study (VEKTIS), 142 entered the 8-month follow-up period during which CsA CE patients remained on their original regimen (CsA CE 4 times daily [QID, high-dose] or CsA CE twice daily [BID, low-dose] + vehicle BID) and vehicle patients were allocated to one of these 2 active regimens. Main outcome measures were safety, including treatment-emergent adverse events, and efficacy, including corneal fluorescein staining (CFS) score.ResultsImprovements in CFS score, rescue medication use, key VKC symptoms (photophobia, tearing, itching, and mucous discharge), and quality of life (QoL) assessed by QUICK questionnaire observed with CsA CE compared with vehicle during the 4-month evaluation period remained stable during the 8-month follow-up period, with the high-dose regimen continuing to provide greater benefits in most efficacy measures. CsA CE was well tolerated. Treatment-related treatment-emergent adverse events during the 12-month study were reported in 15 (20.8%) and 11 (15.7%) of the CsA CE high-dose and low-dose patients, respectively, most commonly instillation site pain (13.9% and 7.1%, respectively). Laboratory data, vital signs, slit lamp examination, best-corrected distance visual acuity, and intraocular pressure raised no safety concerns.ConclusionsImprovements in keratitis, symptoms, and QoL achieved after CsA CE treatment for 4 months remained stable over the 8-month follow-up period. CsA continued to maintain a favorable safety profile.
       
  • Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in
           Presbyopic Patients: A Prospective, Observational Case Series
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): John S.M. Chang, Sylvia C.T. Liu, Jack C.M. Ng, Pak Ling MaPurposeWe report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision.DesignProspective, observational case series.MethodsTwenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and −1.25 to −1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire.ResultsMean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were −0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost>1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P> .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required.ConclusionsMonovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.
       
  • Imbalance of Matrix Metalloproteinases and Their Inhibitors Is Correlated
           With Trabeculectomy Outcomes in Acute Primary Angle Closure
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Tianwei Qian, Mingshui Fu, Chunling Hu, Zhihua Zhang, Xun Xu, Haidong ZouPurposeTo analyze matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and their molar ratios in the aqueous humor in previous acute primary angle closure (APAC) patients and their correlations with trabeculectomy outcomes.DesignProspective cohort study.MethodsAqueous humor samples were collected from a total of 78 eyes, including 52 previous APAC eyes and 26 cataract eyes. TIMP-1, 2, 3, and 4 and MMP-1, 2, 3, 7, 8, 9, 12, and 13 analyte concentrations were measured using multiplexed immunoassay kits. Patient follow-up occurred at 1 week and 1, 3, 6, 12, and 18 months.ResultsIn the previous APAC group, 11 MMP/TIMP molar ratios were significantly lower. APAC eyes were then followed for up to 18 months after trabeculectomy and divided into success (37 eyes) and failure (15 eyes) groups. Five out of the 11 molar ratios were significantly lower in the failure group than in the success group. In multiple logistic regression analysis, failed filtration surgery was more likely in APAC eyes with lower MMP-2/TIMP-2 (P = .040, odds ratio = 44.499) and MMP-13/TIMP-1 (P = .034, odds ratio = 37.947) ratios. Previous APAC eyes were divided according to MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios. Compared to eyes with high ratios, eyes with low MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios had significantly higher failure rates.ConclusionsIn previous APAC eyes, changes in MMP and TIMP levels resulted in MMP and TIMP imbalance. Lower MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios in aqueous humor are risk factors for trabeculectomy failure. Modulating specific MMP/TIMP ratios may have potential clinical applications for filtration surgery.
       
  • The Relationship of Age and Other Baseline Factors to Outcome of Initial
           Surgery for Intermittent Exotropia
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Michael X. Repka, Danielle L. Chandler, Jonathan M. Holmes, Sean P. Donahue, Darren L. Hoover, Brian G. Mohney, Paul H. Phillips, Ann U. Stout, Benjamin H. Ticho, David K. Wallace, Pediatric Eye Disease Investigator GroupPurposeTo determine whether age at surgery is associated with surgical outcome of intermittent exotropia (IXT) at 3 years.DesignSecondary analysis of pooled data from a randomized trial.MethodsA total of 197 children 3 to
       
  • Schlemm’s canal and trabecular meshwork features in highly myopic eyes
           with early intraocular pressure elevation after cataract surgery
    • Abstract: Publication date: Available online 14 February 2020Source: American Journal of OphthalmologyAuthor(s): Jiao Qi, Wenwen He, Qiang Lu, Keke Zhang, Yi Lu, Xiangjia ZhuAbstractPurposeTo investigate the morphological features of Schlemm’s canal and trabecular meshwork in highly myopic eyes with early intraocular pressure (IOP) elevation after cataract surgery.DesignRetrospective case-control studyMethodsEighty-eight highly myopic eyes of 88 patients after uneventful cataract surgery were included, 31 of which had early postoperative IOP elevation and 57 of which did not. The morphological features of Schlemm’s canal and trabecular meshwork, collected with swept-source optical coherence tomography before surgery, were reviewed. Backwards stepwise multiple linear regression was used to investigate the anatomical risk factors for early IOP elevation in highly myopic eyes.ResultsHighly myopic eyes with early postoperative IOP elevation had smaller Schlemm’s canal vertical diameter and area, as well as smaller trabecular meshwork thickness and width, in each quadrant than the non-elevation group. There was no significant difference in Schlemm’s canal horizontal diameter between the IOP elevation and non-elevation groups. In the highly myopic eyes, average Schlemm’s canal vertical diameter, Schlemm’s canal area, trabecular meshwork thickness and width were all correlated negatively with the IOP elevation. A multivariate analysis showed that average Schlemm’s canal vertical diameter (β = -0.262, p = 0.004) and trabecular meshwork thickness (β = -0.173, p < 0.001) were significantly associated with early transient IOP elevation in highly myopic cataract eyes.ConclusionsA smaller vertical diameter of Schlemm’s canal and a thinner trabecular meshwork are two anatomical risk factors for early IOP elevation after cataract surgery in highly myopic eyes.
       
  • In Vivo Corneal Confocal Microscopy and Histopathology of Keratitis Fugax
           Hereditaria from a Pathogenic Variant in NLRP3
    • Abstract: Publication date: Available online 12 February 2020Source: American Journal of OphthalmologyAuthor(s): Joni A. Turunen, Annamari T. Immonen, Reetta-Stiina Järvinen, Sabita Kawan, Pauliina Repo, Anna Korsbäck, Olli Ala-Fossi, Aino M. Jaakkola, Anna Majander, Minna Vesaluoma, Tero T. KiveläAbstractPurposeTo apply in vivo corneal confocal microscopy (IVCM) to study the pathogenesis of keratitis (keratoendotheliitis) fugax hereditaria, an autosomal dominant cryopyrin-associated periodic keratitis, associated with the c.61G>C pathogenic variant in the NLRP3 gene, in its acute and chronic phase, and to report histopathological findings after penetrating keratoplasty.DesignObservational case seriesMethodsStudy population: Six patients during an acute attack, 18 patients in the chronic phase, and one patient who underwent penetrating keratoplasty.Intervention: Sanger sequencing for the NLRP3 variant c.61C>G. Clinical examination, corneal photography, IVCM, light microscopy and immunohistochemistry. Main Outcome Measures: IVCM and histopathological findings.ResultsDuring the acute attack, hyperreflective cellular structures consistent with inflammatory cells transiently occupied the anterior to middle layers of the corneal stroma. Other corneal layers were unremarkable. With recurring attacks, central oval stromal opacities accumulated. IVCM revealed that they contained long hyperreflective needle-shaped structures in extracellular matrix. By light microscopy, the anterior half of the stroma displayed thin and finely vacuolated lamellae, and keratocytes throughout the stroma were immunopositive for syndecan.ConclusionsThe acute attacks and chronic stromal deposits mainly involve the anterior to middle layers of the corneal stroma, and the disease is primarily a keratitis rather than a keratoendotheliitis. IVCM shows that inflammatory cells invade only the stroma during an acute attack. IVCM and light microscopic findings suggest that the central corneal opacities represent gradual deposition of extracellular lipids. The disease could make a good in vivo model to study activation of the NLRP3 inflammasome in cryopyrin-associated periodic syndromes.
       
  • Quantification of choriocapillaris with Phansalkar’s local
           thresholding: pitfalls to avoid
    • Abstract: Publication date: Available online 12 February 2020Source: American Journal of OphthalmologyAuthor(s): Zhongdi Chu, Yuxuan Cheng, Qinqin Zhang, Hao Zhou, Yining Dai, Yingying Shi, Giovanni Gregori, Philip J. Rosenfeld, Ruikang K. WangAbstractPurposeTo demonstrate the proper use of the Phansalkar’s local thresholding method (Phansalkar method) in choriocapillaris (CC) quantification with optical coherence tomography angiography (OCTA).DesignRetrospective, observational case series.MethodsSwept source OCTA imaging was performed using 3x3 mm and 6x6 mm scanning patterns. The CC slab was extracted following semi-automatic segmentation of the retinal pigment epithelium/Bruch’s membrane complex. Retinal projection artifacts were removed before further analysis, and CC OCTA images from drusen eyes were compensated using a previously published strategy. CC flow deficits (FDs) were segmented with two previously published algorithms: fuzzy C-means approach (FCM method) and Phansalkar method. With the Phansalkar method, different parameters were tested and a local window radius of 1-15 pixels was used. FD density (FDD), mean FD size (MFDS) and FD number (FDN) were calculated for comparison.ResultsSix normal eyes from six subjects and six eyes with drusen secondary to age-related macular degeneration from six subjects were analyzed. With both 3x3 mm and 6x6 mm scans from all eyes, the FD metrics were highly dependent on the selection of the local window radius when using the Phansalkar method. Larger window radii resulted in higher FDD values. FDN increased with the increase in the window radius but then decreased, with an inflection point at about 1 – 2 inter-capillary distances (ICDs). MFDS decreased then increased with increasing window radii.ConclusionsMultiple parameters, especially the local window radius, should be optimized before using the Phansalkar method for the quantification of CC FDs with OCTA imaging. It is recommended that the proper use of the Phansalkar method should include the selection of the window radius that is related to the expected ICD in normal eyes.
       
  • Reply
    • Abstract: Publication date: Available online 11 February 2020Source: American Journal of OphthalmologyAuthor(s): Andrew J. Rong, Elizabeth A. Vanner, Richard K. Parrish, Swarup S. Swaminathan
       
  • Punctiform and Polychromatic Pre-Descemet Corneal Dystrophy: Clinical
           Evaluation and Identification of the Genetic Basis
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Jorge L. Alió del Barrio, Doug D. Chung, Olena Al-Shymali, Alice Barrington, Kavya Jatavallabhula, Vinay S. Swamy, Pilar Yébana, Maria Angélica Henríquez-Recine, Ana Boto-de-los-Bueis, Jorge L. Alió, Anthony J. AldavePurposeThis study reports the clinical features and genetic bases of 3 previously unreported families with punctiform and polychromatic pre-Descemet corneal dystrophy (PPPCD).DesignObservational case series.MethodsFull ophthalmic assessment was performed for members of 3 unreported families with PPPCD. Structural and biomechanical alterations of the cornea were screened. Whole exome sequencing (WES) was performed in the first family. Novel or rare variants that segregated with the affected status were screened in the other 2 families using Sanger sequencing. Identified variants that segregated with the affected status in all families were characterized by using in silico prediction tools and/or in vitro splice assays. Additionally, 2 previously reported PPPCD families were screened for variants identified in the 3 unreported PPPCD families.ResultsPPPCD was diagnosed in 12 of the 21 examined members of the 3 unreported families. The only refractive, topographic, or biomechanical abnormality associated with PPPCD was a significantly increased corneal stiffness. WES and Sanger sequencing identified 2 variants that segregated with the affected status in all 3 families: a rare intronic PDZD8 c.872+10A>T variant and a novel missense PRDX3 c.568G>C (p.Asp190His) variant. The same PRDX3 variant was identified in the previously reported PPPCD family expressing the common PPPCD phenotype and was predicted by in silico prediction tools to be damaging to protein function.ConclusionsPPPCD is associated with an alteration of corneal biomechanics and a novel missense variant in PRDX3. Screening of additional families will determine whether all families demonstrate a PRDX3 variant or whether locus heterogeneity may exist for PPPCD.
       
  • Effect of Surgical Indication and Preoperative Lens Status on Descemet
           Membrane Endothelial Keratoplasty Outcomes
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Rénuka S. Birbal, Lamis Baydoun, Lisanne Ham, Alina Miron, Korine van Dijk, Isabel Dapena, Martine J. Jager, Stefan Böhringer, Silke Oellerich, Gerrit R.J. MellesPurposeTo analyze 6-month results of 1000 consecutive Descemet membrane endothelial keratoplasty (DMEK) cases, and to evaluate if outcomes are influenced by surgical indication and preoperative lens status.DesignRetrospective, interventional case series.MethodsA series of 1000 eyes (738 patients) underwent DMEK mainly for Fuchs endothelial corneal dystrophy (FECD; 85.3%) or bullous keratopathy (BK; 10.5%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density, postoperative complications, and retransplantations.ResultsAt 6 months after DMEK, there was no difference in BCVA outcome between FECD and BK eyes (P = .170), or between phakic and pseudophakic FECD eyes (P = .066) after correcting for patient age and preoperative BCVA. Endothelial cell loss at 6 months postoperatively was similar for phakic and pseudophakic FECD eyes (39%; P = .852), but higher for BK eyes than for FECD eyes (46% vs 39%, P = .001). Primary and secondary graft failure occurred in 3 (0.3%) and 2 eyes (0.2%), respectively, and 7 eyes developed allograft rejection (0.7%). Eighty-two eyes (8.2%) received rebubbling for graft detachment and retransplantation was performed in 20 eyes (2.0%). Rebubbling was more often required in eyes treated for BK vs FECD eyes (12.4% vs 7.4%, P = .022).ConclusionDMEK consistently provides excellent short-term results, with similar high visual acuity levels for both FECD and BK eyes. As preoperative lens status did not influence DMEK outcomes, for phakic FECD eyes with a still relatively clear crystalline lens, lens preservation may be preferable in a selected group of younger patients, who may still benefit from their residual accommodative capacity.
       
  • Visual Outcomes in Presumed Congenital Foveal Toxoplasmosis
    • Abstract: Publication date: Available online 7 February 2020Source: American Journal of OphthalmologyAuthor(s): Margaret MM. Reynolds, Smith Ann M. Chisholm, Richard Schroeder, Gregg T. LuederAbstractPurposeCongenital macular lesions attributed to toxoplasmosis may limit potential visual acuity. The appearance and location of these scars may cause physicians to overlook associated amblyopia. This study reviews the visual outcomes and benefits of amblyopia therapy in children with foveal toxoplasmosis scars.DesignRetrospective observational case seriesMethods.SettingSingle centerPatient populationChildren with with presumed foveal toxoplasmosis scars who underwent amblyopia treatment.Main outcome measureCharts were reviewed for amblyopia treatment, fundus photographs, optical coherence tomography (OCT), and visual acuity.ResultsMedian age at presentation was 2.8 years old and median follow-up was 6.2 years. Occlusion therapy was undertaken in nine patients. Median duration of occlusion therapy was years. Six patients improved with occlusion therapy (average 4.6 lines gained on optotype acuity). Final visual acuity ranged from 20/25 - 20/250, with 6 of 8 patients better than 20/80. OCT confirmed macular scars in five patients, with varying degrees of foveal architecture disruption.ConclusionDespite the striking appearance of the lesions in patients with presumed foveal toxoplasmosis, visual potential may be better than expected. The appearance of the lesions is not always predictive of visual outcome. A trial of occlusion therapy to treat amblyopia should be initiated in these patients to ensure that they reach their maximal visual potential.
       
  • Diabetic Retinopathy Screening Using a Gold Nanoparticle–Based Paper
           Strip Assay for the At-Home Detection of the Urinary Biomarker
           8-Hydroxy-2'-deoxyguanosine (8-OHdG)
    • Abstract: Publication date: Available online 6 February 2020Source: American Journal of OphthalmologyAuthor(s): Dean P. Hainsworth, Abilash Gangula, Shreya Ghoshdastidar, Raghuraman Kannan, Anandhi UpendranAbstractPurposeTo assess a smartphone-based, gold nanoparticle (AuNP)–based colorimetric lateral flow immunoassay paper sensor for quantifying urine 8-hydroxy-2’-deoxyguanosine (8-OHdG) as a biomarker for diabetic retinopathy (DR) screening.MethodsPaper strips incorporate AuNP–8-OHdG antibody conjugates which produce color changes that are proportional to urine 8-OHdG and discernible on a smartphone camera photograph. Paper strip accuracy, precision, and stability studies were performed with 8-OHdG solutions of varying concentrations. Urine was collected from 97 diabetic patients receiving DR screening examinations, including seven-field fundus photographs. DR was graded by standard methods: low risk (no or mild DR) and high risk (moderate or severe DR). Paper sensor assays were performed on urine samples from patients, and 8-OHdG values were correlated with DR grades. The differences in 8-OHdG values between the low- and high-risk groups were analyzed for outliers to identify the threshold 8-OHdG value that would minimize false-negative results.ResultsLateral flow immunoassay paper strips quantitatively measure 8-OHdG and were found to be accurate, precise and stable. Average urine 8-OHdG concentrations in study patients were 22 ± 10 ng/mg of creatinine in the low-risk group and 55 ± 11 ng/mg of creatinine in the high-risk group. Screening cutoff values of 8-OHdG> 50 ng/mg of creatinine or urine creatinine>1.5 mg minimized screen failures, with 91% sensitivity and 81% specificity.ConclusionsUrinary 8-OHdG is a useful biomarker to screen DR. Quantitative 8-OHdG detection with the lateral flow immunoassay paper sensor and smartphone camera demonstrates its potential in DR screening.
       
  • Rate of Complete Catheterization of Schlemm's Canal and Trabeculotomy
           Success in Primary and Secondary Childhood Glaucomas.
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Carin Rojas, Brenda L. BohnsackPurposeDespite the increasing use of microcatheters to perform 360-degree trabeculotomy, the rate of complete Schlemm's canalization in different forms of pediatric glaucoma is under-reported.DesignRetrospective institutional observational case series.MethodsOcular diagnoses and surgical details of 60 pediatric patients (≤18 years old) who underwent trabeculotomy between 2013 and 2019 were collected. Surgical success was defined as an intraocular pressure (IOP) of 5-20 mm Hg and no additional IOP-lowering surgery.ResultsEighty-five eyes of 60 patients underwent trabeculotomy. For bilateral cases, the first eye to undergo surgery was included for analysis. Diagnoses included primary congenital glaucoma (PCG n = 22), juvenile open angle glaucoma (JOAG n = 16), glaucoma following cataract surgery (GFCS n = 15), and other secondary forms of glaucoma (n = 7). Canalization using a microcatheter was attempted in 52 of 60 eyes (87%) of which 21 (40%) achieved full 360-degree. Complete canalization was attained in 69% of JOAG patients, which was significantly higher than in PCG patients (22%; P = 0.007), but not GFCS (36%) and other secondary glaucoma (29%). The 5-year survival rate for all eyes was 75% with 95% confidence interval (CI), 57 to 86. Survival curves for 360-degree catheter, 270-degree to 360-degree combined catheter/Harms trabeculotome, and
       
  • Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A
           Cluster Analysis Approach
    • Abstract: Publication date: Available online 4 February 2020Source: American Journal of OphthalmologyAuthor(s): Rose M. Gilbert, Rachael L. Niederer, Michal Kramer, Lazha Sharief, Yael Sharon, Asaf Bar, Sue Lightman, Oren Tomkins-NetzerAbstractPurposeTo develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC).DesignCross-sectional and longitudinal observational study.Methods.SettingMulticenter: UK and IsraelPopulationA clinical database of 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC.Observation ProcedureEyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multi-modal imaging features, by observers masked to original diagnoses. Multivariate two-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analysed for between-group differences.Main Outcome MeasureDifferences between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis.ResultsThe subject age range was 11 to 89 years with a baseline best corrected visual acuity of 2.3 to -0.2 (LogMAR). Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00D (spherical equivalent). Cluster analysis prioritised clinical criteria of chorio-retinal lesion location and intraocular inflammation and identified two distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation the initial clinical diagnosis remained stable for the vast majority of eyes and only one eye (0.3%) changed diagnosis from PIC to MFC due to newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in CNV development and treatment received.ConclusionsCluster analysis of this large cohort of eyes identified peripheral lesions and intra-ocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for the vast majority of eyes. This methodology could be useful for future uveitis classification and management.
       
  • Sectorwise Visual Field Simulation Using Optical Coherence Tomographic
           Angiography Nerve Fiber Layer Plexus Measurements in Glaucoma
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Liang Liu, Ou Tan, Eliesa Ing, John C. Morrison, Beth Edmunds, Ellen Davis, Seema Gupta, Lorinna H. Lombardi, Yali Jia, David HuangPurposeTo simulate 24-2 visual field (VF) using optical coherence tomographic angiography (OCTA) for glaucoma evaluation.DesignCross-sectional study.MethodsOne eye each of 39 glaucoma and 31 age-matched normal participants was scanned using 4.5-mm OCTA scans centered on the disc. The peripapillary retinal nerve fiber layer plexus capillary density (NFLP-CD, %area) was measured. The NFLP-CD and 24-2 VF maps were divided into 8 corresponding sectors using an extension of Garway-Heath scheme.ResultsSector NFLP-CD was transformed to a logarithmic dB scale and converted to sector simulated VF deviation maps. Comparing simulated and actual 24-2 VF maps, the worst sector was in the same or adjacent location in the same hemisphere 97% of the time. VF mean deviation (VF-MD) was simulated by NFLP mean deviation (NFLP-MD). The differences between NFLP-MD and VF-MD in early, moderate, and severe glaucoma stages were −0.9 ± 2.0, 0.9 ± 2.9, and 5.8 ± 3.2 dB. NFLP-MD had better (P = .015) between-visit reproducibility (0.63 dB pooled standard deviation) than VF-MD (1.03 dB). NFLP-MD had a significantly higher sensitivity than VF-MD (P < .001) and overall NFL thickness (P = .031).ConclusionsOCTA-based simulated VF agreed well with actual 24-2 VF in terms of both the location and severity of glaucoma damage, with the exception of severe glaucoma in which the simulation tended to underestimate severity. The NFLP-MD had better reproducibility than actual VF-MD and holds promise for improving glaucoma monitoring. The NFLP-MD had better diagnostic accuracy than both VF-MD and overall NFL thickness and may be useful for early glaucoma diagnosis.
       
  • Distinctive Mechanisms and Patterns of Exudative Versus Tractional
           Intraretinal Cystoid Spaces as Seen With Multimodal Imaging
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Andrea Govetto, David Sarraf, Jean-Pierre Hubschman, Ramin Tadayoni, Aude Couturier, Ismael Chehaibou, Adrian Au, Christelle Grondin, Gianni Virgili, Mario R. RomanoPurposeTo determine clear-cut distinctions between tractional and exudative intraretinal cystoid spaces subtypes.DesignRetrospective, multicenter, observational case series.MethodsA cohort of patients diagnosed with intraretinal cystoid spaces and imaged with optical coherence tomography (OCT), fluorescein angiography (FA), blue fundus autofluorescence (BFAF), en face OCT, and OCT angiography (OCT-A) was included in the study. All images were qualitatively and quantitatively evaluated.ResultsIn this study were included 72 eyes of 69 patients. Exudative intraretinal cystoid spaces (36/72 eyes, 50%) displayed a “petaloid” morphology as seen with en face OCT, FA, and BFAF. Tractional intraretinal cystoid spaces (24/72 eyes, 33.3%), displayed a radial “spoke-wheel” en face OCT pattern. There was no leakage with FA and BFAF did not reveal specific patterns. Eyes with full-thickness macular hole (FTMH, 12/72 eyes, 16.7%) displayed a “sunflower” en face OCT appearance. FTMH showed OCT, OCT-A, and BFAF features of both exudative and tractional cystoid spaces, but without any FA leakage. Inner nuclear layer (INL) thickness was significantly lower in tractional cystoid spaces (P < .001). There were a greater number of INL cystoid spaces in both the exudative and FTMH subgroups (P = .001). The surface area of INL cystoid spaces was significantly lower in the tractional subgroup (P < .001). There was a significant reduction of the microvascular density in eyes with exudative vs tractional (P = .002) and FTMH (P < .001) subgroups.ConclusionsExudative and tractional intraretinal cystoid spaces displayed characteristic multimodal imaging features and they may represent 2 different pathologic conditions with equally different clinical implications.
       
  • Longitudinal Changes in Ganglion Cell–Inner Plexiform Layer of Fellow
           Eyes in Unilateral Neovascular Age-Related Macular Degeneration
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Min-Woo Lee, Ju-mi Kim, Hyung-Bin Lim, Yong-Il Shin, Young-Hoon Lee, Jung-Yeul KimPurposeTo determine longitudinal changes in the ganglion cell–inner plexiform layer (GC-IPL) thickness of the fellow eyes of patients with neovascular age-related macular degeneration (AMD).DesignProspective cohort study.MethodsPatients with unilateral neovascular AMD, unilateral polypoidal choroidal vasculopathy (PCV), and control subjects were included. After the initial visit, GC-IPL thickness was measured twice more with at least a 1-year interval between examinations using spectral domain optical coherence tomography.ResultsTwenty-seven fellow eyes of patients with unilateral choroidal neovascularization (CNV), 33 fellow eyes of patients with unilateral PCV, and 35 eyes of control subjects were enrolled. The GC-IPL thickness of the fellow eyes was 78.41 ± 9.23, 81.20 ± 5.52, and 81.60 ± 3.83 μm in the CNV, PCV, and control groups, respectively, and they showed a significant change over time (P < .001, P = .001, and P = .003, respectively). The reduction rate of GC-IPL thickness was −0.88, −0.41, and −0.31 μm per year in the fellow eyes of the CNV, PCV, and control groups, respectively (CNV> PCV, control, P < .001). In a linear mixed model determination of factors associated with GC-IPL reduction in the fellow eyes of the CNV group, the interaction between baseline GC-IPL thickness and duration showed a significant result (P < .001).ConclusionsThe fellow eyes of patients with neovascular AMD showed a greater reduction rate of GC-IPL thickness compared with fellow eyes of patients with unilateral PCV and control subjects. In patients with unilateral neovascular AMD, fellow eyes with a thicker GC-IPL at baseline showed a greater reduction in GC-IPL thickness over time.
       
  • The Effect of a Ptosis Procedure Compared to an Upper Blepharoplasty on
           Dry Eye Syndrome
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Ofira Zloto, Adham Matani, Daphna Prat, Ari Leshno, Guy Ben SimonPurposeTo examine the effect of combined blepharoplasty and Müller muscle-conjunctival resection (MMCR) compared to an upper blepharoplasty on dry eye syndrome.DesignProspective, comparative clinical study.MethodsThis is prospective, comparative case series. Two groups of patients participated in this study: the blepharoplasty group included adult patients with dermatochalasis and the ptosis group consisted of adult patients with dermatochalasis and ptosis that showed significant improvement after phenylephrine 10% instillation. The following parameters were compared for all patients before the procedure (baseline) and on postoperative day 90: MRD1, Ocular-Surface-Disease-Index (OSDI), Schirmer test 2, tear break-up time (TBUT), fluorescein staining, Lissamine-green staining (LG).ResultsFifty-four patients participated in this study (blepharoplasty group: 23 patients, ptosis group 31 patients). There were significant increases in the postoperative LG scores and in fluorescein staining post ptosis surgery compared with the preoperative values (paired t test, P = .05 and P = .02, respectively). The postoperative OSDI score was significantly higher post ptosis surgery compared with the preoperative score (25.38 vs 17.24, respectively, paired t test, P < .01). There were no significant differences, in the blepharoplasty group, between the postoperative and preoperative objective and subjective dry eye tests.ConclusionsMMCR surgery causes an increase in the subjective feeling of dry eye as well as an increase of signs of dry eye. This increase was not noticed after blepharoplasty surgery. Physicians should be aware of the risk of dry eye after ptosis surgery and discuss dry eye as a complication of MMCR surgery with their patients before surgery. Those patients should be examined carefully and treated for dry eye during follow-up.
       
  • Retinal Vessel Density in Exudative and Nonexudative Age-Related Macular
           Degeneration on Optical Coherence Tomography Angiography
    • Abstract: Publication date: April 2020Source: American Journal of Ophthalmology, Volume 212Author(s): Sophie C. Lee, Steven Tran, Aana Amin, Lawrence S. Morse, Ala Moshiri, Susanna S. Park, Glenn YiuPurposeAlthough the choroid contributes to the pathogenesis of age-related macular degeneration (AMD), the role of retinal perfusion is unclear. We sought to compare retinal vascular measurements between eyes with nonexudative and exudative AMD using optical coherence tomography angiography (OCT-A).DesignRetrospective, cross-sectional study.MethodsOCT-A images were analyzed from 310 eyes of 182 patients (mean age ± standard deviation [SD], 78.8 ± 8.8 years) with nonexudative (54.2%) and exudative (45.8%) AMD to measure retinal vessel density (VD) from the superficial capillary plexus in the foveal, parafoveal, and full macular regions and foveal avascular zone (FAZ) area, perimeter, and circularity. Multivariate regressions were used to compare nonexudative and exudative AMD eyes and the impact of anti–vascular endothelial growth factor (anti-VEGF) treatments or geographic atrophy (GA).ResultsIn eyes with AMD, VD decreases with age in the foveal (β = −0.211, P < .001), parafoveal (β = −0.305, P < .001), and full macular regions (β = −0.295, P < .001). Eyes with exudative AMD demonstrated lower VD, especially in the parafoveal (29.8% ± 6.3% vs 33.0% ± 5.7%, P < .001) and full regions (27.9% ± 6.2% vs 31.2% ± 5.5%, P < .001) compared with nonexudative AMD. There were no differences in FAZ area, perimeter, or circularity between the 2 groups (P = .503–.907). In eyes with exudative AMD, previous anti-VEGF treatments did not impact retinal vascular measurements (P = .324–.986). Nonexudative AMD severity and presence of central GA also impacted retinal VD and FAZ morphology.ConclusionsRetinal VD is decreased in eyes with exudative AMD compared with nonexudative AMD but is unaffected by anti-VEGF treatments, suggesting a retinal vascular contribution to the pathogenesis of AMD.
       
  • Clinical Implications of Goblet Cells in Dacryoadenosis and Normal Human
           Lacrimal Glands
    • Abstract: Publication date: Available online 30 January 2020Source: American Journal of OphthalmologyAuthor(s): Frederick A. Jakobiec, Ralph C. Eagle, Martin Selig, Lina Ma, Carol ShieldsAbstractPurposeTo investigate an enlarged dacryoadenotic lacrimal gland and normal lacrimal glands for the presence of goblet cells (mucocytes).DesignRetrospective clinicopathologic series.MethodsAn enlarged lacrimal gland (dacryoadenosis) without obvious histopathologic alterations was extensively evaluated histochemically, immunohistochemically, and ultrastructurally to detect the presence of goblet cells and to compare the findings with those in five normal lacrimal glands.ResultsGranular, zymogen-rich pyramidal acinar cells in normal glands predominated over a previously Not reported subpopulation of non-granular, pale staining cells in both dacryadenotic and normal lacrimal glands. These cells histochemically stained positively with mucicarmine and Alcian blue. Immunohistochemical and electron microscopic evaluations established that there was a displacement or replacement of cytoplasmic gross cystic disease fluid protein-15 and CK 7-positive tonofilaments in the pale acinar cells by myriad mucus granules. Goblet cells constituted approximately 2 % of the normal acinar cells and 5% of dacryoadenotic acinar cells. A depletion of myoepithelial cells and ectopic intra-acinar ductular cells were also observed in dacryoadenosis.ConclusionDacryodenosis is caused by an increase in the number of acini without individual acinar cell hyperplasia. A normal cytologic feature of the lacrimal gland is the presence of acinar goblet cells that had been long overlooked; they are increased in number in dacryoadenosis. Intra-acinar ductular cells and the scattered loss of myoepithelial cells are other abnormalities in dacryoadenosis. The presence of lacrimal gland goblet cells may have physiologic implications for the pre-corneal tear film and its derangements as well as for the histogenesis of mucus-producing carcinomas.
       
  • Reply to: Comment on: PLACE Trial Report No. 3
    • Abstract: Publication date: Available online 29 January 2020Source: American Journal of OphthalmologyAuthor(s): Thomas J. van Rijssen, Elon H.C. van Dijk, Paula Scholz, Myrte B. Breukink, Rocio Blanco-Garavito, Eric H. Souied, Jan E.E. Keunen, Robert E. MacLaren, Giuseppe Querques, Sascha Fauser, Susan M. Downes, Carel B. Hoyng, Camiel J.F. Boon
       
  • Predictors of Neovascular Glaucoma in Central Retinal Vein Occlusion
    • Abstract: Publication date: Available online 28 January 2020Source: American Journal of OphthalmologyAuthor(s): Jagdeep Singh Gandhi
       
  • Comment on: van Rijssen TJ, van Dijk EHC, Scholz P, et al. Focal and
           Diffuse Chronic Central Serous Chorioretinopathy Treated With Half-Dose
           Photodynamic Therapy or Subthreshold Micropulse Laser: PLACE Trial Report
           No. 3
    • Abstract: Publication date: Available online 27 January 2020Source: American Journal of OphthalmologyAuthor(s): Jeffrey K. Luttrull
       
  • Progression of Retinopathy Secondary to Maternally Inherited Diabetes and
           Deafness – Evaluation of Predicting Parameters
    • Abstract: Publication date: Available online 24 January 2020Source: American Journal of OphthalmologyAuthor(s): Philipp L. Müller, Tim Treis, Maximilian Pfau, Simona Degli Esposti, Abdulrahman Alsaedi, Peter Maloca, Konstantinos Balaskas, Andrew Webster, Catherine Egan, Adnan TufailAbstractPurposeTo investigate the prognostic value of demographic, functional, and imaging parameters on retinal pigment epithelium (RPE) atrophy progression secondary to Maternally Inherited Diabetes and Deafness (MIDD) and to evaluate the application of these factors in clinical trial design.DesignRetrospective observational case series.MethodsThirty-five eyes of 20 patients (age range, 24.9-75.9 years) with genetically proven MIDD and demarcated RPE atrophy on serial fundus autofluorescence (AF) images were included. Lesion size and shape-descriptive parameters were longitudinally determined by two independent readers. A linear mixed effect model was used to predict the lesion enlargement rate based on baseline variables. Sample size calculations were performed to model the power in a simulated interventional study.ResultsThe mean follow-up time was 4.27 years. The mean progression rate of RPE atrophy was 2.33 mm2/year revealing a dependence on baseline lesion size (+0.04 [0.02-0.07] mm2/year/mm2, p
       
  • Long-Term Follow-Up of Normal Tension Glaucoma Patients With TBK1 Gene
           Mutations in One Large Pedigree
    • Abstract: Publication date: Available online 24 January 2020Source: American Journal of OphthalmologyAuthor(s): Tyler S. Quist, Chris A. Johnson, Alan L. Robin, John H. FingertAbstractPurposeTo characterize features of glaucoma associated with a TANK binding kinase 1 (TBK1) gene duplication, which is among the most common molecularly defined causes of normal tension glaucoma (NTG).DesignRetrospective observational case seriesMethodsWe conducted a retrospective case series, by reviewing medical records of 7 members of a pedigree with normal tension glaucoma (NTG) caused by TBK1 gene duplications. Clinical features of these patients at diagnosis, throughout management, and at latest follow up were identified including age, intraocular pressure (IOP), central corneal thickness (CCT), optic nerve head appearance, and mean deviation (MD) assessed with Humphrey visual field (HVF) testing protocols.ResultsAt initial diagnosis, the mean age was 35 ± 7 years, IOP was 16 ± 2.1 mm Hg, cup-to-disc (C/D) ratio was 0.9 ± 0.08, and MD assessed via HVF 30-2 and/or 24-2 testing protocols was -9.0 ± 8.9 (range: -1.8 to -27) dB in the 14 study eyes. At initial diagnosis, 4 (28%) of 14 eyes had no visual field defect, 4 (28%) had early visual field defects, and 6 (43%) had severe visual field defects. Patients had a mean follow-up of 21.5 ± 9.0 years and experienced an average reduction of IOP by 28%. Four of 12 eyes (33%) had stable visual fields throughout follow-up, while 8 eyes (67%) had slow to moderate progression. The 30-2 and/or 24-2 HVF tests had an average change in MD of -0.53 ± 0.26 dB/year. No eyes had rapid progression with a MD> 1.0 dB/year. At final follow up, the mean IOP was 11.5 ± 2.9, and C/D ratio was 0.94 ± 0.4. At final follow up, 3 (21%) of 14 eyes had early visual field defects, 4 (29%) of 14 eyes had moderate visual field defects, and 7 (50%) had severe visual field defects. Six (43%) of 14 eyes met criteria for legal blindness.ConclusionsWe provide the first report of the clinical features and long-term clinical course in a family of NTG patients with TBK1 gene duplications. TBK1-associated glaucoma exhibits classic features of NTG. Patients present with severe disease at a relatively early age and most (67%) have slow to moderate progression of their visual field fields. The rate of visual field change appears correlated with the magnitude of IOP, suggesting that it may be advantageous to set extremely low IOP targets for some patients with TBK1-associated glaucoma.
       
  • Automated diagnosis of diabetic retinopathy using clinical biomarkers,
           optical coherence tomography (OCT), and OCT angiography
    • Abstract: Publication date: Available online 23 January 2020Source: American Journal of OphthalmologyAuthor(s): Harpal Singh Sandhu, Mohammed Elmogy, Nabila El-Adawy, Ahmed Eltanboly, Ahmed Shalaby, Robert Keynton, Ayman El-BazAbstractPurposeTo determine if combining clinical, demographic, and imaging data improves automated diagnosis of nonproliferative diabetic retinopathy (NPDR).DesignCross-sectional imaging and machine learning study.MethodsThis was a retrospective study performed at a single academic medical center in the United States. Inclusion criteria were age> 18 and a diagnosis of diabetes mellitus (DM). Exclusion criteria were non-DR retinal disease and inability to image the macula. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed, and data on age, gender, hypertension, hyperlipidemia, and hemoglobin A1c were collected. Machine learning techniques were then applied. Multiple pathophysiologically important features were automatically extracted from each layer on OCT and each OCTA plexus and combined with clinical data in a random forest classifier to develop the system, whose results were compared to the clinical grading of NPDR, the gold standard.Results111 patients with DM II were included in the study, 36 with DM without DR, 53 with mild NPDR, and 22 with moderate NPDR. When OCT images alone were analyzed by the system, accuracy of diagnosis was 76%, sensitivity 85%, specificity 87%, and area under the curve (AUC) was 0.78.When OCT and OCTA data together were analyzed, accuracy was 92%, sensitivity 95%, specificity 98%, and AUC 0.92. When all data modalities were combined, the system achieved an accuracy of 96%, sensitivity 100%, specificity 94%, and AUC 0.96.ConclusionsCombining common clinical data points with OCT and OCTA data enhances the power of computer-aided diagnosis of NPDR.
       
  • Addendum to: Validation of a Prognostic Staging for Metastatic Uveal
           
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Tero Kivelä, Sophie Piperno-Neumann, Laurence Desjardins, Alexander Schmittel, Nikolaos Bechrakis, Edoardo Midena, Serge Leyvraz, Leonidas Zografos, Jean-Daniel Grange, Guillaume Ract-Madoux, Ernest Marshall, Bertil Damato, Sebastian Eskelin
       
  • OCT Angiography Features of Neovascularization as Predictive Factors for
           Frequent Recurrence in Age-Related Macular Degeneration
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Mihyun Choi, Seong-Woo Kim, Cheolmin Yun, Jaeryung OhAbstractPurposeTo investigate the features of neovascularization (NV) in eyes with neovascular age-related macular degeneration (NVAMD) using optical coherence tomography angiography (OCTA) according to the treatment interval of intravitreal aflibercept injection (IVI).DesignRetrospective, interventional, comparative case series.MethodsPatients with type 1 NV treated with the “pro-re-nata” regimen after three loading IVI were classified into two groups based on the numbers of treatments during 12 months, specifically a stable group who required less than two injections and an unstable group who required more than three injections. Quantitative features of OCTA including NV area, NV length, NV density, endpoint density (open-ended vessels per unit length), junction density (vessel junction per unit length), lacunarity, and largest vessel caliber were compared between the two groups.ResultsAmong 71 eyes, 38 and 33 eyes were classified into the stable and unstable groups, respectively. The unstable group had higher endpoint densities (stable vs. unstable: 2.74 vs. 3.08; p = 0.03) and higher levels of lacunarity (0.177 vs. 0.211; p = 0.028). The area, density, length of NV and junction density and largest vessel caliber were not different between the two groups (p= 0.057, p = 0.184, p = 0.062, p = 0.160, and p = 0.473). Endpoint density was correlated with the unstable group in both univariate and multivariate analyses (p = 0.004, p = 0.002, respectively). A predictive model with an endpoint index demonstrated a sensitivity of 93.75% and a negative predictive value of 89.47% for the unstable group.ConclusionsThe characteristics of NV in eyes of exudative AMD with type 1 NV were different according to treatment requirements. Identifying the features of NV on OCTA might be helpful for predicting clinical outcomes and optimal treatment intervals.
       
  • Morning myopic shift and glare in advanced Fuchs endothelial corneal
           dystrophy
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Niklas Loreck, Werner Adler, Sebastian Siebelmann, Alexander C. Rokohl, Ludwig M. Heindl, Claus Cursiefen, Björn O. Bachmann, Mario MatthaeiAbstractPurposeImpaired subjective morning visual acuity with improvement of symptoms during the day is pathognomonic for corneal endothelial dysfunction in advanced Fuchs endothelial corneal dystrophy (FECD). This study aimed to analyze the daily fluctuations of corneal thickness, refraction, and (glare) visual acuity in advanced FECD.DesignProspective cohort study.MethodsPatients with advanced FECD (FECD group) and patients with normal cornea (control group) were enrolled. Routine clinical examination was performed using slitlamp biomicroscopy, funduscopy, macular OCT. In addition, assessment using corneal Scheimpflug tomography (Pentacam), refraction, corrected distance visual acuity (CDVA) and glare CDVA was performed at 4pm (afternoon) and the following day at 8am (morning).ResultsA total of 29 FECD eyes and 22 control eyes were included. Diurnal variations from afternoon to morning were Δcorneal thickness (apex) ± standard deviation (SD) 41.45±34.1μm (p
       
  • Localization in glaucomatous visual field loss vulnerable to
           posture-induced intraocular pressure changes in open angle glaucoma
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Yusuke Manabe, Akira Sawada, Tetsuya YamamotoAbstractPurposeTo investigate localization in glaucomatous visual field defect vulnerable to posture-induced intraocular pressure (IOP) changes.DesignProspective cross-sectional studyMethodsNinety-three eyes of 93 newly-diagnosed cases with normal tension glaucoma were examined. The IOP was measured in both the sitting and lateral decubitus positions with an Icare rebound tonometer. Visual field tests were performed with a Humphrey Field Analyzer with the Central 30-2 program using Swedish Interactive Threshold Algorithm standard strategies. The total deviation (TD) map values of 51 tested points were used for the analysis. A regression analysis was conducted to investigate relationships between TD in each point or cluster and posture-induced IOP changes. A linear mixed-effects model was used to identify factors associated with TD changes in each visual field cluster.Main Ootcome MeasuresRelationship between posture-induced IOP changes and localization of visual field defect.ResultsThere were 54 women and 39 men (mean age, 53.4 ± 12.5 years). The mean IOP per Icare rebound tonometer was 15.5 ± 3.2 mmHg in the sitting position and 18.8 ± 3.1 mmHg in the lateral decubitus position. The postural IOP difference was +3.3 ± 1.8 mmHg (P < .001; range, -1.0 to 7.7 mmHg). There was a significant negative correlation between TD and posture-induced IOP changes in four contiguous central points located just above the horizontal meridian. A linear mixed-effects model revealed a significant association between the difference in postural IOP change and decreased TD in the superior paracentral visual field according to multivariate analysis (P = .010).ConclusionsPosture-induced IOP variation have been shown to be associated with glaucomatous superior paracentral visual field defect.
       
  • Comparison of techniques for correction of chin-down vertical abnormal
           head position associated with infantile nystagmus syndrome
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): James J. Law, Yuxi Zheng, Derick G. Holt, David G. Morrison, Sean P. DonahueAbstractPurposeWe evaluated the relative effectiveness of combined recession-resection of vertical rectus muscles versus superior rectus recession with inferior oblique weakening for patients who underwent surgical correction of chin-down abnormal head position (AHP) associated with infantile nystagmus syndrome (INS).DesignRetrospective interventional case series.MethodsReview of 22 patients who underwent surgical correction of chin-down vertical AHP associated with INS at an academic institution. The primary outcome was collapse of AHP. Unfavorable outcomes included repeat surgery, induced strabismus, in addition to failure of collapse of AHP.ResultsTwenty-two patients had chin-down AHP. Recession-resection (BSRc 6-9 mm; BIRs 5-9 mm) was performed in 11 cases; weakening of both elevators (BSRc 5-8 mm, BIOc or myectomy) in 11 cases. Unfavorable outcome rates were 64% (7/11) compared with 18% (2/11), respectively (P = 0.03). Re-operation was performed for 6/22 patients. Five were from the recession-resection group, namely three for induced V-pattern esotropia, one for alternating esotropia, and one to correct recurrent AHP. The last of the 6 who requied reoperation was in the elevator weakening group, and required correction of a recurrent AHP (P = 0.06).ConclusionsWhile recession-resection of the vertical recti and weakening of both elevators each produce acceptable collapse of chin-down AHP, the former frequently induces a V-pattern esotropia requiring re-operation.
       
  • Determining and comparing the effective lens position and refractive
           outcome of a novel rhexis-fixated lens to established lens designs
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Mehdi Shajari, Ruven Sonntag, Theresa Niermann, Detlef Holland, Thomas Kohnen, Siegfried Priglinger, Wolfgang J. MayerabstractPurposeTo evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOL) with plate-haptic, c-loop haptic and a rhexis fixated lens were compared.SettingDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Department of Ophthalmology, Goethe-University, Frankfurt, Germany. nordBlick Eye Clinic, Kiel, Germany.DesignRetrospective, multicenter, comparative case series.MethodsThe study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic or a novel rhexis fixated IOL. Biometry and refraction measurements were conducted pre- and three months postoperatively. Lens constant optimization was performed.ResultsSeventy eyes of 56 subjects were included. ELP for rhexis fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis fixated IOL and both plate-haptic (P=0.001) and c-loop haptic IOL (P=0.000). ACD adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P
       
  • Reply to Correspondence: Trends in Retina Specialist Imaging Utilization
           From 2012 to 2016 in the United States Medicare Fee-for-Service Population
           
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Turner D. Wibbelsman, Ravi R. Pandit, David Xu, Thomas L. Jenkins, Phoebe L. Mellen, Rebecca R. Soares, Anthony Obeid, Hannah Levin, Jason Hsu, Allen C. Ho
       
 
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